Provider Demographics
NPI:1881901510
Name:SHARMA, ANUJ
Entity type:Individual
Prefix:MR
First Name:ANUJ
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15755 LAKESIDE VILLAGE DR
Mailing Address - Street 2:APT 305
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6093
Mailing Address - Country:US
Mailing Address - Phone:248-882-2093
Mailing Address - Fax:
Practice Address - Street 1:15755 LAKESIDE VILLAGE DR
Practice Address - Street 2:APT 305
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6093
Practice Address - Country:US
Practice Address - Phone:248-882-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist